Some Occipital Aches.—Occasionally I have found that people who complained of a sense of weight at the back of the head, with some muscular tenderness, were sleeping on pillows that were too high. They were over-exerting these muscles and this gave a sense of fatigue, which when much attention was paid to it, became such an ache or at least discomfort as is often found in the occupation neuroses. I have seen schemata according to which headache complained of at the top of the head meant digestive disturbance, headache in the anterior portion of the head was referred to the eyes or the brain, and headache at the back of the head spinal exhaustion or severe neurasthenia, but these are at most very uncertain and I do not think that the tabulation of cases justifies any such diagram of absolute causes and effect. Usually there is some local condition that calls particular attention to a special part of the head and then the attention being concentrated complaint is made of that part.
Local Head Discomfort.—Usually a headache, accompanied by a localized sense of pressure or weight or constriction, occurs in highly neurotic people or those inclined to think much of themselves and whose attention becomes concentrated on some part. At all times we have sensations streaming up to our consciousness from every portion of the body and anyone who wants to think about them, or a particular set of them, can make them sources of considerable discomfort by concentration of attention. Sometimes there are special conditions that predispose to these localized sensory disturbances. I have known tight hats to produce such effects. It is sometimes surprising how tightly hats are worn. Nervous people are prone to overdo everything, and they overdo the pulling down of their hats. At times the wearing of a heavy hat will be the root of the trouble. I have known nervous men accustomed to wearing high hats all their lives who began to complain of headache when they were in the midst of busy worries and troubles of late life, find considerable relief by abandoning their high hats.
Toxic Headaches.—There are headaches that are due to the taking of stimulants, as is well known from common experience. The mistake is often made, however, of thinking that only alcoholic stimulation will cause a severe headache. Tea and coffee headaches may be quite as severe. Whenever people complain much of headache it is important to revise their dietary as to the consumption of tea and coffee. Of course, the headaches following [{553}] alcoholic stimulation are usually recognized as such, though occasionally a man accustomed to taking much alcohol without any such after effects is surprised in the midst of the worry incident to business stresses to find that he is having headaches. These are due to the combination of stimulants and congestion consequent upon an excess of alcohol with the increased brain work that is demanded, or even with the same amount of brain work from a tired brain. Gradually stopping the alcohol will do more to relieve these headaches than anything else. To advise the sudden stoppage of regular quantities of spirits that have been taken for some time, will sometimes produce an anemic headache and defeat the purpose of the advice.
When for some other reason tea or coffee or alcoholic stimulants are suddenly omitted after they have been taken to excess for some time, patients' complain of a headache. Some of this is probably imaginary, or at least is due to the idea that their craving for the stimulant, whatever it may be, must have a local manifestation, and the head sensation is exaggerated as a consequence. Tea and coffee cravings may here give more trouble than the longing for alcohol. Sometimes there may be a real disturbance of the circulation from the lack of the heart stimulant to which the system is accustomed and therefore an uncomfortable feeling in the head from brain anemia. This can be overcome by not cutting off the stimulant, whatever it may be, all at once, but by bringing about its gradual cessation. These patients, however, are very prone, even with the best of good will in the matter, to deceive themselves and find an excuse for not having their favorite tipple, be it tea or coffee or alcohol, taken from them, so that they readily create symptoms by auto-suggestion.
Direct Mental Treatment.—For both congestive and anemic headaches mental treatment is important. For those suffering from the congestive kind the physicians's business is not so much the cure of any one attack of headache (for this can be accomplished by various now rather familiar anodyne drugs as a rule), but the discovery and removal of the cause for the recurring attacks. These will be found in some habit of the patient which must be corrected. Drugs are seldom needed for the underlying condition which occasions the headache, for when it is due to such organic affections as brain tumors or other intracranial lesions, drugs can accomplish very little. In less serious conditions benefit may be obtained by having the patient change his attitude towards certain important details of his life, such as eating, sleeping, attention to business or to study and the like, so as to prevent the mistakes of daily habit that predispose to headache.
With regard to anemic headaches, especially those which occur in persons who are very much run down in weight, the most important element of treatment is to bring about an increase in weight. This can be accomplished much better through the mind than in any other way. Appetite is a function of the will, and patients should have an increase of diet dictated to them and then be persuaded to follow that. I have seen many a headache disappear among teachers, and religious workers particularly simply as the result of this measure.
As regards headaches for which no definite cause can be found mental treatment is the only efficient remedy. Practically nothing but a change of mental attitude towards the affection and its underlying causes, whether these [{554}] be neurotic or psychic, will bring about relief, and each patient is a problem quite distinct from any other.
There is no pretense that this use of mental healing for headache is new or even modern. Many stories show that in olden times headaches were often relieved by this means, and that suggestion was looked upon as an important element in the treatment for their relief. In the chapter on [Great Physicians in Psychotherapy] the quotation from Plato with regard to Socrates curing the headache of his young friend Charmides illustrates this very well.
In the old stories of Greek medicine there are a number of references to headaches cured by suggestion or at least by mental influence. Miss Hamilton, in her book on "Incubation," [Footnote 40] tells the story of Agestratos and his headaches and how they were cured at Epidaurus. Agestratos had a combination of headache and insomnia, the description of the ailments having a strangely modern air. Just as soon as he came to the Temple at Epidaurus he fell asleep and had a dream. The God of Medicine, AEsculapius, whose cult was practiced assiduously at Epidaurus, came to him in his sleep and promised him the cure of his headache and at the same time taught him wrestling and advised its practice. When day came he departed cured, and continued to practice wrestling. Not long after he competed at the Nemean Games and was victor in the racing. The suggestion that his headache would get better had come to him and at the same time he had been given a suggestion that provided him with occupation of mind and body. Many of the people who suffer from persistent headaches need this advice more than anything else. Probably every physician has had the experience of headaches being cured by some interesting exercise, especially if taken in the open air. The important factor is the change of mental attitude, though changes in exercise, diet, amount of sleep and the like are helpful auxiliaries.
[Footnote 40: London, 1906.]